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Comments ...

 +0  (nbme20#32)

super vague question ! Dr denies assisting suicide=> nonmaleficience do everything he can to manage her pain => beneficience

 +0  (nbme20#17)

Thiazide=> hypercalcemia=> Oxytoxin (Gq coupled protein-> incr Ca2+)=> nipple discharge

 +0  (nbme21#20)

There's a band cell in the middle=> left shift reactive granulocytosis

 +0  (nbme21#37)

be aware that the x-axis for this question is not "Km" (vitB6 is not the subtrate that's 1/[VitB6]. to simpify, because the Vmax is gonna stay the same, you just need to increase [vitB6] to get the same Vmax (aka shift to right on the x-axis). Don't be fooled around by the question writer.

Subcomments ...

submitted by breis(9),

Patient has Midsystolic murmur heard at the cardiac apex. there is also a LEFT ATRIAL abnormality. Echo shows LEFT ATRIUM is enlarged.

Mid systolic... enlarged left atrium...

Best choice: Mitral Regurg

hpsbwz  Why is it regurg instead of stenosis? +  
minhphuongpnt07  Vague question requires a lot clinical reasoning. mitral regurgitation: holosystolic murmur( this cv: midsystolic), enlarged LA, LV Mitral stenosis: diastolic murmur, enlarged LA, normal LV. only best explanation I can think of: early stage Mitral regur, that's why the murmur is not holosystolic but midsystolic and LV still adequately handle the situation +  
dickass  @hpsbwz it's regurgitation because the murmur is SYSTOLIC, when the mitral valve is not supposed to make any sound. mitral valve leaks in systole, which causes blood to back up, which causes the left atrium to work harder and eventually hypertrophy. Mitral stenosis would be a DIASTOLIC sound, which is when the left atrium normally contracts. +  

In psychogenic polydipsia, serum sodium is low, and after water deprivation test, urine osmolality is increased. Urine osmolality does not increase with vasopressin injection

In nephrogenic diabetes insipidus, serum sodium is high and there is no change/mild increase in urine osmolality after water deprivation

yotsubato  This patient does not undergo a water deprivation test +4  
niboonsh  Compulsive water drinking or psychogenic polydipsia is now increasingly seen in psychiatric populations. Effects of increased water intake can lead to hyponatremia causing symptoms of nausea, vomiting, seizures, delirium and can even be life threatening if not recognized and managed early. +2  
missi19998  Just wondering why it in not resistance to ADH action of vasopressin +  
amarousis  because he would be hypernatremic with no ADH. can't resorb any water +1  
minhphuongpnt07  low osm/urine, low os/plasma => psychogenic polydipsia +